Meditation, prayer and spiritual healing: the evidence.

Kaiser Permanente (KP) is well recognized as an innovator and industry leader in providing cost-effective, population-based, and preventive care for its members. These same principles are reflected also in the goals and strategies of KP's National Diabetes Program. The goal of the Care Management Institute's National Diabetes Program is to provide high-quality, cost-effective, and evidence-based care to reduce morbidity and mortality in members with diabetes. However, when this goal is competing with other short-range targets and resource requests, it often becomes challenging to implement. Maintaining focus on this larger goal is especially crucial when translating evidence into practice. Although the National Diabetes Program's evidence-based guidelines cover a broad scope from prevention of diabetes to screening to self-management, these guidelines must be prioritized and translated into cost-effective programs and initiatives that lead to improved clinical outcomes. As one of KP's oldest care management programs, the diabetes program has gone through many changes. In the process, the program has focused on a few important principles for identifying priority goals: Implement programs that move toward decreasing morbidity, decreasing mortality, and saving money. Use evidence as the foundation of the work. Assess program effectiveness, either by using simulation modeling or by analyzing real-world impact. Continually reevaluate the program, adjust it, and implement it again. In its history, the diabetes program has undergone three cycles of change. With its successes and failures, each cycle demonstrates how following all four of these principles can ultimately lead to successful programs. Expert Opinion: In the first cycle, programs were developed solely on the basis of expert opinion but with limited success. Risk Stratification and Testing: In the second cycle, evidence-based medicine (EBM) was subsequently incorporated, but a lack of focus on clinical outcomes led to suboptimal results. Outcomes Focus: Finally, in the third cycle, EBM was incorporated into an outcomes-focused program; modeling predicts that this will lead to an improvement in outcomes and significant cost savings for the organization.